Thirteen new urgent care centers seek N.H. licenses

New Hampshire patients in need of quick access to health care are going to have many more options, especially in more rural areas of the state.

Thirteen urgent care or outpatient clinics – including one in Belmont and one in Hillsboro – will petition the state next Thursday for approval to open.

The new facilities, if approved by the state’s Health Services Planning and Review board, would bring the total number of nonemergency walk-in care centers in the state to 42. Last August, there were 23 such facilities licensed in the state.

The petitions are likely to be approved because all 13 applications are below the financial threshold that triggers a full review.

The threshold, which is set in statute and revised through a formula including inflation, is about $2 million. Wentworth-Douglass Hospital, ConvenientMD and ClearChoiceMD estimated their new facilities will require an investment of between $380,000 and $1.9 million, according to the board agenda.

The surge in applications for the January meeting is likely connected to a statutory change in that formula scheduled to begin Feb. 1, which will include the cost of a facility’s lease in the calculation, potentially pushing some into the review process.

The new applications, however, point to the expanded reach of the industry beyond New Hampshire’s traditional population centers.

Marcus Hampers, chief executive officer of ClearChoiceMD, which is proposing five new clinics in New Hampshire and more in Vermont, is the former medical director for ConvenientMD.

He said he parted from the Portsmouth-based company on good terms, but that he struck out on his own after seven months because he saw a need for urgent care centers beyond the Interstate 93 corridor where ConvenientMD had launched. Representatives of ConvenientMD, which is proposing seven new clinics, could not be reached this week.

In planning to open clinics in Belmont and Hillsboro, ClearChoiceMD “is not throwing a dart at a map,” Hampers said.

“We’re opening in locations that are not as glamorous as Manchester and Nashua, but there’s a methodical analysis,” he said. “Previously, maybe those rural areas would have a high uninsured and Medicaid population that would be a problem for urgent care. . . . But with the Affordable Care Act, all of these people are going to be privately insured. Everyone’s going to have insurance, so you have the population, and the need, and a lack of competition.”

The urgent care clinic industry has been growing steadily over several years in much of the United States, but has only recently experienced sudden growth in New Hampshire.

The surge in applications this month “doesn’t surprise me,” said John Martin, manager of the state Bureau of Licensing and Certification.

“What surprises me,” he said, “is it didn’t happen sooner.”

There are a number of reasons the urgent care clinic industry is growing, but experts agreed that the biggest is patients’ inability to get care from a family physician, whether because they don’t have insurance or they can’t wait for an appointment. National surveys estimate there are thousands fewer primary care physicians available than needed.

Hospital officials and established primary care doctors in the region have spoken against the new clinics.

“I worry a little bit whether it is going to be an issue of lack of continuity . . . if their primary care doctor is in the hospital system and they go elsewhere,” said Mike Green, Concord Hospital’s recently retired chief executive officer, when ConvenientMD first announced its plans to open in the city.

Pediatrician Patricia Edwards was more direct in a recent Monitor column: “The addition of walk-in clinics damages the medical home and fractionates the care of our patients.

“All the pediatricians in the Concord area have been working through the years with the Concord Hospital ER and urgent care at Horseshoe Pond to develop good patient care. We have no relationship with the walk-in clinics that are springing up all over, so we don’t even know what type of care they provide,” she wrote.

“This is not a new phenomenon, though it’s new to New Hampshire,” said Dr. David Green, chief medical officer of Concord Hospital. “But to understand all the consequences this might bring about at this point is challenging.”

The broadest definition of urgent care, as defined by the Urgent Care Association of America, is health care provided on a walk-in, no-appointment basis for acute illness or injury that is not life- or limb-threatening, and is either beyond the scope or availability of the typical primary care practice or retail clinic.

There were about 9,000 facilities in the U.S. that met this definition as of September 2011, the most recent year for which the Urgent Care Association of America has conducted a survey.

The state, however, defines walk-in care centers as facilities where a person can come in from the street without an appointment and without having an established relationship with the provider, and without intent to establish one.

That means the six recently approved Minute Clinics at CVS locations across the state are included in that count, though they provide a narrower scope of services than others.

For example, urgent care clinics are equipped to stitch wounds, set minor fractures and take X-ray images, while physician offices and “retail clinics” like the ones at CVS aren’t.

“It’s really important the public understands the difference between primary care and urgent care. Primary care that is about health maintenance and disease management is different than urgent care, which is episodic for illness and injury,” Hampers said.

The idea that the Concord area doesn’t want or need urgent care clinics “isn’t borne out in the analysis,” he said. “If there’s no need, the free market will run its course and the clinics will go out of business.”

(Sarah Palermo can be reached at 369-3322 or spalermo@cmonitor.com or on Twitter @SPalermoNews.)

Having been in the urgent care business for more than 20 years, I understand the importance of continuity of care. The key is educating the public on when and how to use urgent care clinics. These clinics should not be seen as competition or replacement of primary care physicians; rather they are convenient and affordable options for patients who need care at all hours, but not necessarily the expensive option of an ER.

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